Bioethics training helps fight African brain drain

Jul 4 2007

When African professionals migrate to the United States or Europe, it's often called brain drain.

In the world of research ethics, at least one training program is causing the opposite effect. Now entering its eighth year of operation, the Johns Hopkins Fogarty African Research Ethics Training Program is the subject of a sweeping new case study published in the July 2007 issue of Academic Medicine. For the first time, the case study reveals some potent lessons in what it takes to deliver a successful, cross-cultural ethics training program.

“We initially sought to increase the critical mass of African individuals professionally trained in ethics,” said Nancy Kass, ScD, deputy director for public health at the Johns Hopkins Berman Institute of Bioethics and the program's director. “But it also turns out that our trainees are making institutional changes to policies, drafting new guidelines, and generally raising awareness of the need to support research ethics. And some trainees are not just doing these things in their home countries, but throughout the continent.”

In a region devastated by the HIV/AIDS epidemic, the trainees provide encouraging evidence of success in the global effort to work collaboratively with African professionals to develop their own ethics-based research methods. After studying in Baltimore for six months under the supervision of a mentor with similar research interests, trainees return to Africa to begin a six-month practicum on the topic of their choice related to the ethics of research. One trainee returned to Zimbabwe, eager to share his newfound expertise at more than 30 workshops in surrounding regions. Another returned to the Democratic Republic of Congo and established two Institutional Review Boards (IRBs). Another trainee helped design international guidelines for HVI vaccines.

“During the practicum, trainees implement all they have learned in the classroom,” said Adnan Hyder, MD, MPH, PhD, the program's co-director and an associate professor of international health at the Johns Hopkins Bloomberg School of Public Health. “The last half of the program attempts to mitigate a familiar problem for researchers in Africa: trying to borrow principles of ethical review from developed countries. Instead, trainees contribute to the research ethics capacity of their home country by setting the agenda themselves. The process transforms students into effective researchers and advocates for the kind of research ethics that will actually work in their own countries.”

The case study reveals that Johns Hopkins Fogarty Bioethics trainees return to Africa well-equipped for the practicum and subsequent work. While at The Johns Hopkins University, trainees attend three intensive courses, multiple seminars, and regular one-on-one mentoring sessions, as well as attend IRB meetings at the university and at the National Institutes of Health.

Despite considerable success stories, the program still faces challenges. The Academic Medicine article demonstrates the importance of maintaining regular contact with trainees upon their return, particularly as many of these trainees face many other professional demands when they return home; in four years, the program lost contact with only one trainee. The program's directors have also learned to require monthly progress reports and to finance each practicum in stages to ensure timely completion.

Backgrounds of the 23 trainees who have gone through the program to date have varied; former trainees include a philosophy professor from West Africa, a pediatrician who works with orphans, an advisor to the Cameroon military, two IRB coordinators, and a young staff member of an HIV vaccine-ethics group.

In 2000, the Fogarty International Center of the National Institutes of Health (NIH) established the International Bioethics Education and Career Development Award. Designed to improve the quality of international ethics training, the program placed a special focus on training for professionals from developing countries. The Johns Hopkins University was one of five institutions in North America originally selected to help the NIH launch the initiative, and selected Africa as its area of focus. Since 2003, three to five scientists from sub-Saharan Africa have participated each year.

One of the largest centers of its kind in the world, the Johns Hopkins Berman Institute of Bioethics is the home for collaborative scholarship and teaching on the ethics of clinical practice, public health, and biomedical science at The Johns Hopkins University. Since 1995, the Institute has worked with governmental agencies, non-governmental organizations, and private sector organizations to address and resolve ethical issues. Institute faculty represent such disciplines as medicine, nursing, law, philosophy, public health, and the social sciences. Their work helps anticipate and inform debates on complex moral challenges; discerns ethically acceptable alternatives in medical, scientific, and public health policy; and helps to prepare the next generation of bioethicists. More information is available at http://www.bioethicsinstitute.org.